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Clin Medicine > Newman Endo Repro > Flashcards

Newman Endo Repro Flashcards

1
Q

List primary symtpoms primary adrenal insuffiency

A

Ok

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2
Q

What space are kidneys and adrenals

A

Retroperitoneum

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3
Q

Short term stress

A

Catecholamines, NE, E

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4
Q

Long term stree

A

Glucocorticoids mineralocorticoids

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5
Q

GFR

A

Glomerulosclerosis, fasciculata, reticularis

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6
Q

Salty sweet spiced

A

Mineralocorticoids, glucocorticoids, sex steroids

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7
Q

Describe HPA axis cortisol

A

Hypothalamus release CRH to anterior pituitary

Anterior pituitary send acth to adrenal cortex

Adrenal cortex makes cortisol which sends negative feedback to anterior pituitary and hypothalamus

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8
Q

RAAS

A

Renin angiotensin aldosterone system

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9
Q

Aldosterone effect

A

Na retention

K secretion

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10
Q

Baby in looked good in nursery and feeding ok. Comes in day 6 thrown up but looks dehydrated, very dry mucous membranes(signs in baby—dry mucous membranes, no tears, anterior fontanells) bp 60/30, sluggish weak cry

Find a female genetalia, looks like a penis? Masculine , clitoramegonly, maasculinzation of female genetalia
VIRILIZED

A

Virilized, low bp, dehydration

21 hydroxylase defiency
Congenital adrenal hyperplasia

Lack of aldosterone

Lack of cortisol and aldosterone…flow over to DHEA< androstenedione, and testerostone

Lose na lose water

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11
Q

Lab work CAH

A

Na low, K high, Cl low, bicarb low, BUN high, glucose low

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12
Q

Why girl better CAH

A

Girl genital show virilization

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13
Q

Why glucose low

A

Cortisol stimulate gluconeogenesis (something insulin)

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14
Q

What order

A

17 a OH

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15
Q

Treat CAH

A

Hydroxycortisone, fluids/glucose, get K level down

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16
Q

Primary adrenal insuffiency

A

Autoimmune (most common cause in US)

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17
Q

Most common infectious cause primary adrenal insuffiency

A

TB-SEE CALCIFICATIONS ON MRI

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18
Q

X linked recessive disorder of long chain FA metabolism

A

Mimic MS

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19
Q

Waterhouse friedreich Sean syndrome

A

Bilateral adrenal hemorrhage

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20
Q

ACTH darkening of the skin

A

MSH of PMC

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21
Q

Inherited adrenal unresponsiveness to ACTH

A

Familial glucocorticoid defiency (AR)

Increase acth causes skin pigmentation

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22
Q

Triple A

A

Rare AR adrenal gland no respond to ACTH so ACTH so high

Mutation int he AAAAS gene that codes for the protein ALADIN

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23
Q

Congenital adrenal hyperplasia

A

21 hydroxylase defiency most common

Salt wasting

Defiency cortisol and aldosterone

Excessive androgens

Sometimes called Addison in older children/adulthood

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24
Q

Adrenal insuffiency how do they present

A

Fatigue, reduced stamina, weakness, anorexia, weight loss, skin hyperpigmentation

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25
Q

What do patients complain of with primary adrenal insuffiency

A

Abdominal pain, nausea, vomiting, msk pain (joint, muscles, chest, back), psychiatric (depression, anxiety, irritability), HA, vomiting, gait disturbance, salt craving and orthostatic light headedness, BP is usually low and orthostatic

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26
Q

Female infant with 21 hydroxylase defiency will have virilized genetalia

A

Ok

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27
Q

Labs primary adrenal insuffiency

A

Na low, K high, low blood sugar, maybe hypercalcemia, plasma cortisol ***

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28
Q

Low 8 am plasma cortisol (low morning high night) and do ACTH level and its high

A

Primary adrenal insuffiency

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29
Q

Confirmatory test

A

Cosyntropin (synthetic acth) stimulation test

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30
Q

If cortisol doesn’t respond to acth

A

Confirm primary corticoinsuffiency

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31
Q

Serum antibodies to 21 hydroxylase

A

Confirm autoimmmune Addison

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32
Q

Lab to see 21 hydroxylase defiency

A

Elevated serum levels of 17 oh progesterone are required

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33
Q

Plasma renin high primary adrenal insuffiency

A

Sense hypovolemia

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34
Q

Treat primary adrenal insuffiency

A

Glucocorticoids replacement therapy, mineralocorticoids therapy

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35
Q

Acute adrenal crisis symptoms

A

Ab pain

Confusion

Dehydration

Dizziness

Fatigue

High fever (

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36
Q

Labs acute adrenal crisis

A

ACTH stimulation test, cortisol blood sugar, K , serum Na, serum pH (

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37
Q

Secondary adrenal insuffiency

A

Low serum ACTH in the setting of low serum cortisol is the give away

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38
Q

32 year old purple tiger stripes on abdomen , high BP, periods irregular, crappy feeling, hump back

A

Striae, Cushing

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39
Q

Cushing

A

Excessive corticosteroids

Vague weird symptoms

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40
Q

ACTH dependent cushing

A

Cushing disease (ACTH secretory adenoma)

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41
Q

ACTH independent cushing syndrome

A

Exogenous corticosteroid use (most common cause)

Adrenocortical tumor

42
Q

Mccune albright syndrome

A

Polycyotic fibrous dysplasia, cafe at lair, endocrine hyperfunction from multiple organ)

43
Q

Extopic acth

A

AAC of lung

44
Q

Cushing disease

A

Pituitary adenoma

45
Q

Cushing syndrome

A

Ectopic acth

SSC of lung

46
Q

Dexamasone test

A

Draw serum acth before

47
Q

ACTH lelvated in hundred, cortisol not suppressed by high or low doses

A

Ectopic acth syndrome is likely

48
Q

Undetectable or low acth, cortisol not suppressed by high or low doses

A

Primary hypercortisolism is likely (not driven by acth, possible adrenal tumor)

49
Q

Normal to elevated acth, cortisol not suppressed by low but suppressed by IgG

A

Cushing disease (pituitary still retains some feedback control)

50
Q

Incidentalomas

A

Accidentally find nodule in adrenal >4 cm have to do work up and makes sure not malignant with CT and MRI

51
Q

All patients with adrenal incidentaloma require testing for _____. How

A

Pheochromocytoma

Plasma metanephrines

Urine collection

52
Q

Primary aldosteronism

A

HTN that is resistant and descent respond to three drugs think of this

53
Q

Conn syndrome

A

Primary aldosteronism secondary to a unilateral aldosterone-producing adrenal adenoma

40% have a mutation in a gene coding for the K channel

54
Q

Signs symtpoms primary aldosteronism

A

HTN and hypokalemia

55
Q

Lab finding primary aldosteronism

A

Metabolic alkalosis (proton lows, H with K)

56
Q

Pheochromocytoma

A

VHL type 2
AD
Get it

Bp high, sweating,

57
Q

Lab pheochromocytoma

A

Plasma fractioned free metanephrines is the single msot sensitive test for secretory pheochromocytoma and paragangliomas

58
Q

Treating suspected pheochromocytoma

A

Alpha blocker before beta blocker otherwise bp can go up

59
Q

MEN

A

AD

Have tumours in 2 or more different endocrine glands

60
Q

Growth curve PEDS : how measure length

A

Laying down

61
Q

Measure height or stature

A

Standing up

62
Q

Over 36 months

A

Standing up

63
Q

Normal BMI kids

A

Percentile

64
Q

Normal weight kids

A

Greater than or equal to 5th percentile and less than 85th percentile

65
Q

Normal weight adult

A

BMI 18,5-24.9

66
Q

6 here’s of age till puberty growth per year

A

2 inches a year

67
Q

Mid parental height

A

Genetic potential …estimate of genetic potential for girls and boys different

68
Q

Weight falls off first

A

Think nutrition

Not getting enough or processing enough

Higher than average caloric requirements

69
Q

Length fallow off first

A

Think endocrine

GH defiency, hypothyroidism, cushing syndrome (iatrogenic)

70
Q

Head circumference falls off first

A

Primary failure of the brain to grow

Severe craniosynstosis

71
Q

Bone age

A

Provides a rough estimate of a kids skeletal maturation by assessing the ossification of the epiphyseal centers

Bone age is 2 SD below the chronological age is considered delayed

72
Q

What bone age is considered delayed

A

2 SD

73
Q

Abnormal growth

A

A comprehensive history and physical is essential in developing the differential diagnosis and guiding the work up

74
Q

What most important of work up of kid not growing well

A

History and physical

75
Q

Evaluating growth. How many points on the growth curve

A

More better

76
Q

Get as many points on growth curve as you can

A

Ok

77
Q

Catch up or catch down

A

First 18 months of life plotting kids make 25% downward adjustment as go from Abby food to solid food. They’ll catch p but a lot make a downward adjustment.

78
Q

Constitutional growth delay

A

Late bloomer, few months big growth

Grow grow grow, slow down then catch back up

79
Q

End height if have precocious puberty

A

Shorter than normal. Growth plates mature cant grow anymore

Grow really fast when dont expect then off

Familial -come form land of little people

80
Q

Cushing curve

A

Gaining weight, but height not up up

81
Q

Short stature

A

Height 2SD less than the 3rd percentile (mean height for age and sex)

Height more than 2SD below the mid parental height

82
Q

Intima work up for concerning short stature and not explained by constitutional, familial, and idiopathic

A

IGF and IGFBP-3 levels

83
Q

IGF and IGFBP-3 levels

A

Insulin like growth factor

84
Q

Turner

A

45 XO with delayed puberty/short stature in females always check a karyotyoe

Web neck
Wide nipples

85
Q

Lab work turner0short stature

A

Check karyotype and see if 45 XO

86
Q

Precocious puberty less than 8 years old girls and 9 in men

A

Full activation of HPG axis before 8 years of age in girls and before 9 years of age in boys

87
Q

Consider precocious puberty in girls

A

Progressive breast development

Crossing major percentile lines upward on the linear growth chart

88
Q

Consider precocious puberty in boys if

A

Evidence of both testicular and penile enlargement

Crossing major percentile lines upward not he linear growth chart

89
Q

Bone age precocious puberty

A

Advanced bone age

90
Q

Premature adrenarche

A

Increase in DHEA and its storage from DHEA-S

Pubic hair, axillary hair ,odor, sometimes acne

91
Q

Straight thin hair

A

No worry

92
Q

Curly thick hair and other secondary sexual characteristics of growth sky rocketing

A

Work up look at growth look at other sexual characteristics

93
Q

Only thin little pubic hair

A

Fine

94
Q

Premature thelarche

A

Breast early

Usually feel bud in kids just watch

If related to acceleration work up as precocious puberty

95
Q

Hypothyroidism

A

Increase BMI from growth arrest with continued weight gain

Family history always watch

96
Q

Tall stature

A

Beckwith-wiedemann syndrome(big head wen young, normal adult height)
Insulin like growth factor 2

97
Q

Homocystinuria

A

Infant of diabetic mother

Big when little

98
Q

Klinefelter syndrome

A

47 XXY

99
Q

Marian

A

AD
Connective tissue

Fibrillin-1 gene mutation genetic consultation

Dissecting aortic aneurysm

100
Q

When refer growth

A

Less than 3rd percentile or greater 95th and continues to rise or drop

Increase growth velocity between schoool age and puberty

Growth potential: projected height varies from midparental height by more than 2 inches

Multiple dystrophic features send to geneticist

Bone age advanced of delayed by more the 2 SF

Clin Medicine (28 decks)

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